Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

INTRODUCTION: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. METHODS: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. INCLUSION CRITERIA: Adult ICU patients>18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48h. Statistical analysis was carried out using IBM-SPSS© 24 programme. RESULTS: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97g/kg/day (CI 0.95-0.99), P<0.001), and lower caloric intake than those who survived (12.94kcal/kg/day (CI 12.48-13.39) vs 16.47kcal/kg/day (CI 16.09-16.8), P<0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II>18. CONCLUSIONS: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina Soporte nutricional en pacientes críticos con enfermedad por coronavirus (COVID-19): un estudio observacional multicéntrico en Argentina

Introduction In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. Methods A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. Inclusion criteria: Adult ICU patients > 18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48 h. Statistical analysis was carried out using IBM-SPSS© 24 programme. Results One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70–0.75 vs 0.97 g/kg/day (CI 0.95–0.99), P < 0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48–13.39) vs 16.47 kcal/kg/day (CI 16.09–16.8), P < 0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II > 18. Conclusions Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Thiamine pharmaconutrition in sepsis: Monotherapy, combined therapy, or neither? Current evidence on safety and efficacy.

Sepsis is a life-threatening condition characterized by multiorgan dysfunction due to an exaggerated host response to infection associated with a homeostatic failure. In sepsis, different interventions, aimed at improving clinical outcomes, have been tested over the past decades. Among these most recent strategies, intravenous high-dose micronutrients (vitamins and/or trace elements) have been investigated. According to current knowledge, sepsis is characterized by low thiamine levels, which are associated with illness severity, hyperlactatemia, and poor clinical outcomes. However, caution is needed about the clinical interpretation of thiamine blood concentration in critically ill patients, and the inflammatory status, based on C-reactive protein levels, should always be measured. In sepsis, parenteral thiamine has been administered as monotherapy or in combination with vitamin C and corticosteroids. Nevertheless, most of those trials failed to report clinical benefits with high-dose thiamine. The purpose of this review is to summarize the biological properties of thiamine and to examine current knowledge regarding the safety and efficacy of high-dose thiamine as pharmaconutrition strategy when administering singly or in combination with other micronutrients in critically ill adult patients with sepsis or septic shock. Our examination of the most up-to-date evidence concludes that Recommended Daily Allowance supplementation is relatively safe for thiamine-deficient patients. However, current evidence does not support pharmaconutrition with high-dose thiamine as a single therapy or as combination therapy aimed at improving clinical outcomes in critically ill septic patients. The best nutrient combination still needs to be determined, based on the antioxidant micronutrient network and the multiple interactions among different vitamins and trace elements. In addition, a better understanding of the pharmacokinetic and pharmacodynamic profiles of intravenous thiamine is needed. Future well-designed and powered clinical trials are urgently warranted before any specific recommendations can be made regarding supplementation in the critical care setting.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

Introduction: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. Methods: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. Inclusion criteria: Adult ICU patients > 18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48 h. Statistical analysis was carried out using IBM-SPSS© 24 programme. Results: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97 g/kg/day (CI 0.95-0.99), P < 0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48-13.39) vs 16.47 kcal/kg/day (CI 16.09-16.8), P < 0.001).A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II > 18. Conclusions: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Introducción: En 2020, la pandemia provocada por el SARS-COV-2 demandó una enorme cantidad de recursos sanitarios para garantizar el tratamiento y apoyo adecuado a estos pacientes. Este estudio tiene como objetivo evaluar la ingesta de calorías/proteínas y evaluar sus asociaciones con resultados clínicos relevantes en pacientes críticamente enfermos con enfermedad por coronavirus (COVID-19). Métodos: Se realizó un estudio observacional prospectivo multicéntrico a nivel nacional que incluyó 12 unidades de cuidados intensivos (UCI) argentinas entre marzo y octubre de 2020. Criterios de inclusión: pacientes adultos de la UCI > 18 años ingresados en la UCI con diagnóstico de COVID-19 y ventilación mecánica durante al menos 48 h. El análisis estadístico se realizó mediante el programa IBM-SPSS© 24. Resultados: En el presente estudio se incluyeron 185 pacientes. Entre los que fallecieron se observó un aporte proteico más bajo (0,73 g/kg/día [intervalo de confianza {IC} del 95% 0,70-0,75] vs. 0,97 g/kg/día [IC 0,95-0,99], p < 0,001), y menor aporte calórico que los que sobrevivieron (12,94 kcal/kg/día [IC 12,48-13,39] vs. 16,47 kcal/kg/día [IC 16,09-16,8], p < 0,001).Se construyó un modelo de regresión logística para analizar qué factores estaban asociados con la probabilidad de lograr los objetivos calóricos/proteicos. Se observó una mayor probabilidad de lograr dichos objetivos cuando el inicio del soporte nutricional era precoz, el puntaje NUTRIC modificado era superior a 5 puntos y el paciente tenía diagnóstico de desnutrición mediante la Evaluación Global Subjetiva(B o C). Por otra parte, en los pacientes que necesitaron ventilación mecánica en decúbito prono se observó menor aporte calórico y proteico, situación similar en aquellos con APACHE II > 18. Conclusiones: Los pacientes críticos con insuficiencia respiratoria asociada a la enfermedad por COVID-19 que requerían ventilación mecánica y que fallecieron en la UCI tuvieron una ingesta calórica y proteica menor que los que sobrevivieron. El inicio temprano del soporte nutricional y la desnutrición aumentaron la posibilidad de alcanzar los objetivos calóricos y proteicos, mientras que la gravedad de la enfermedad y la ventilación mecánica en decúbito prono disminuyeron la posibilidad de alcanzar los objetivos calóricos y proteicos.

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19.

INTRODUCTION: Introduction: the COVID-19 pandemic put the world's population at risk. As the relationship between nutritional risk and clinical outcomes in critically ill patients with COVID-19 is still poorly understood, a multidisciplinary research team of the Argentine Society of Intensive Care (SATI) conducted a multicenter study aimed to define nutritional features, and to evaluate the relationship between nutritional risk and relevant clinical outcomes for COVID-19 patients in an intensive care unit (ICU). Methods: a multicenter, prospective, observational study including twelve Argentinian ICUs was conducted between March and October 2020. Inclusion criteria were: adult patients older than 18 years who were admitted to the ICU with a COVID-19 diagnosis were included. Clinical data included comorbidities scores, and nutritional screening tools such as the Subjective Global Assessment (SGA), the Nutritional Risk Screening (NRS) 2002, and the modified NUTRIC score (mNUTRIC SCORE) were used. In addition, clinical outcomes including overall mortality, mechanical ventilation (MV) days, and ICU and hospital length of stay (LOS) were recorded. Results: a total of 285 ICU patients met our inclusion criteria. Mean age was 61.24 (SD = 14.6) years; APACHE-II, 14.2 (SD = 6.6); Charlson Comorbidity Index (CCI), 2.3 (SD = 2.3). Most patients were admitted from the emergency room to the ICU. Hypertension, obesity, and diabetes were the most common comorbidities. Nutritional assessment showed that 36.9 % were SGA B+C, and 46 % were obese. Mean ICU LOS was 22.2 (SD = 19.5), and hospital LOS was 28.1 (SD = 21.9) days. Of all patients, 90.2 % underwent MV, and MV days were 20.6 (SD = 15.6). The univariate and multivariate analyses showed that risk factors for COVID-19 mortality were (odds ratio [95 % confidence interval]): SGA score of B or C: 2.13 [1.11-4.06], and NRS 2002 ≥ 3: 2.25 [1.01-5.01]. Conclusions: in the present study, nutritional status (SGA) and NRS 2002 were major mortality risk factors for CODIV-19 patients in the ICU.

INTRODUCCIÓN: Introducción: la pandemia de COVID-19 puso en riesgo a la población mundial. Dado que la relación entre el riesgo nutricional y los resultados clínicos en pacientes críticos con COVID-19 es aún poco conocida, un equipo de investigación multidisciplinario de la Sociedad Argentina de Cuidados Intensivos (SATI) realizó un estudio multicéntrico con el objetivo de definir las características nutricionales y evaluar la relación entre el riesgo nutricional y los resultados clínicos relevantes para los pacientes de la unidad de cuidados intensivos (UCI) de COVID-19. Métodos: entre marzo y octubre de 2020 se realizó un estudio observacional prospectivo y multicéntrico que incluyó 12 UCI argentinas. Criterios de inclusión: se incluyeron pacientes adultos mayores de 18 años que habían ingresado en la UCI con diagnóstico de COVID-19. Se utilizaron datos clínicos que incluían scores de comorbilidades, herramientas de cribado nutricional como la Evaluación Global Subjetiva (EGS) y el Cribado de Riesgo Nutricional (NRS) 2002, y la puntuación NUTRIC. Además. Se registraron los resultados clínicos, incluida la mortalidad, los días de ventilación mecánica (VM) y la duración de la estancia en la UCI y hospitalaria en general. Resultados: en total, 285 pacientes en UCI cumplieron nuestros criterios de inclusión. La edad media fue de 61,24 (DE = 14,6) años, la puntuación APACHE-II de 14,2 (DE = 6,6) y el índice de comorbilidad de Charlson (ICC) de 2,3 (DE = 2,3). La mayoría de los pacientes ingresaron desde la sala de emergencias a la UCI. La hipertensión, la obesidad y la diabetes fueron las comorbilidades más frecuentes. La evaluación nutricional mostró que el 36,9 % eran VGS B + C y el 46 % eran obesos. La estancia en la UCI fue de 22,2 (DE = 19,5) y la hospitalaria de 28,1 (DE = 21,9) días. El 90,2 % se sometieron a VM, siendo la media de días de VM de 20,6 (DE = 15,6). El análisis univariado y multivariado mostró que los factores de riesgo de mortalidad por COVID-19 eran (razón de posibilidades [intervalo de confianza del 95 %]): puntuación SGA de B o C: 2,13 [1,11-4,06], y NRS 2002 ≥ 3: 2,25 [1,01-5,01]. Conclusiones: en el presente estudio, el estado nutricional (EGS) y el NRS 2002 fueron los principales factores de riesgo de mortalidad para los pacientes con COVID-19 en la UCI.

Nutritional therapy in critically ill patients with COVID-19. A case review Terapia nutricional no paciente crítico com COVID-19. Uma revisão

Resumen: Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos -incluido una menor sobrevida en UCI- son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI. Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2. Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés. Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2;sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas. Summary Introduction: acute respiratory distress syndrome and multiple organ dysfunction, which determine admission to the ICU, are a significant cause of morbimortality in patients with COVID-19. The patients with the worst clinical outcome, including a shorter survival in the ICU, are those with multiple comorbilities, different immunocompromised states, older adults and individuals with a history of malnutrition or suffering from malnutrition secondary to a critical illness. The nutritional impact of the critical illness on the striated appearance of skeletal muscle fibers may be exacerbated in some critically ill patients who are infected with SARS-CoV-2 and need to be admitted to the ICU. Objective: this article aims to provide useful practical guidelines for clinicians based on updated clinical evidence and considering a few key characteristics that are specific to severe infection caused by SARS-Cov-2. Method: we conducted a thorough review of the scientific literature published until April 2020 in English and Spanish. Conclusions: the COVID-19 pandemic causes an unprecedented challenge in the ICU since up until today, no preventive measures have been proved successful to avoid evolution to critical illness and the therapies available for this stage of the disease are supported by quality clinical evidence. Within this complex framework we may trust that the measures that contribute to strengthening the immune system and ICU life-support therapies (including nutritional therapy) constitute essential tools to fight against severe infections caused by SARS-Cov-2. However, further studies are needed in the ICU scenario for specific recommendations to be made. Resumo Introdução: o desconforto respiratório agudo e a falência de múltiplos órgãos que determinam a admissão na UTI são causas importantes de morbimortalidade em pacientes com COVID-19. Os pacientes com os piores resultados clínicos, incluindo menor sobrevida na UTI, são aqueles com múltiplas comorbidades, graus variáveis ??de imunocomprometimento, idosos e indivíduos com desnutrição prévia ou secundária à doença crítica. O impacto nutricional da doença crítica no músculo esquelético pode ser exacerbado em alguns pacientes graves infectados com SARS-CoV-2 que requerem internação na UTI. Objetivos: o objetivo deste artigo é fornecer orientação prática útil para os médicos baseada em evidências clínicas atualizadas e considerando certas características específicas principais da infecção grave por SARS-Cov-2. Métodos: foi realizada uma revisão exaustiva da literatura científica publicada até abril de 2020 em espanhol e inglês. Conclusões: a pandemia de COVID-19 determina um desafio sem precedentes na UTI, visto que atualmente não existem medidas preventivas comprovadas para prevenir a progressão a doença crítica e os tratamentos curativos disponíveis nesta fase da doença carecem de evidências clínicas de qualidade que os sustentem. Nesse cenário complexo, medidas que contribuem para estimular o sistema imunológico e terapias de suporte na UTI (incluindo suporte nutricional) são provavelmente armas substanciais contra infecções graves por SARS-Cov-2;no entanto, são necessários mais estudos em ambiente de UTI para fazer recomendações específicas.

Nutritional therapy in critically ill patients with COVID-19. A case review Terapia nutricional no paciente crítico com COVID-19. Uma revisão

Resumen: Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos -incluido una menor sobrevida en UCI- son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI. Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2. Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés. Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2;sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas. Summary Introduction: acute respiratory distress syndrome and multiple organ dysfunction, which determine admission to the ICU, are a significant cause of morbimortality in patients with COVID-19. The patients with the worst clinical outcome, including a shorter survival in the ICU, are those with multiple comorbilities, different immunocompromised states, older adults and individuals with a history of malnutrition or suffering from malnutrition secondary to a critical illness. The nutritional impact of the critical illness on the striated appearance of skeletal muscle fibers may be exacerbated in some critically ill patients who are infected with SARS-CoV-2 and need to be admitted to the ICU. Objective: this article aims to provide useful practical guidelines for clinicians based on updated clinical evidence and considering a few key characteristics that are specific to severe infection caused by SARS-Cov-2. Method: we conducted a thorough review of the scientific literature published until April 2020 in English and Spanish. Conclusions: the COVID-19 pandemic causes an unprecedented challenge in the ICU since up until today, no preventive measures have been proved successful to avoid evolution to critical illness and the therapies available for this stage of the disease are supported by quality clinical evidence. Within this complex framework we may trust that the measures that contribute to strengthening the immune system and ICU life-support therapies (including nutritional therapy) constitute essential tools to fight against severe infections caused by SARS-Cov-2. However, further studies are needed in the ICU scenario for specific recommendations to be made. Resumo Introdução: o desconforto respiratório agudo e a falência de múltiplos órgãos que determinam a admissão na UTI são causas importantes de morbimortalidade em pacientes com COVID-19. Os pacientes com os piores resultados clínicos, incluindo menor sobrevida na UTI, são aqueles com múltiplas comorbidades, graus variáveis ??de imunocomprometimento, idosos e indivíduos com desnutrição prévia ou secundária à doença crítica. O impacto nutricional da doença crítica no músculo esquelético pode ser exacerbado em alguns pacientes graves infectados com SARS-CoV-2 que requerem internação na UTI. Objetivos: o objetivo deste artigo é fornecer orientação prática útil para os médicos baseada em evidências clínicas atualizadas e considerando certas características específicas principais da infecção grave por SARS-Cov-2. Métodos: foi realizada uma revisão exaustiva da literatura científica publicada até abril de 2020 em espanhol e inglês. Conclusões: a pandemia de COVID-19 determina um desafio sem precedentes na UTI, visto que atualmente não existem medidas preventivas comprovadas para prevenir a progressão a doença crítica e os tratamentos curativos disponíveis nesta fase da doença carecem de evidências clínicas de qualidade que os sustentem. Nesse cenário complexo, medidas que contribuem para estimular o sistema imunológico e terapias de suporte na UTI (incluindo suporte nutricional) são provavelmente armas substanciais contra infecções graves por SARS-Cov-2;no entanto, são necessários mais estudos em ambiente de UTI para fazer recomendações específicas.

Nutritional therapy in critically ill patients with COVID-19. A case review / Terapia nutricional en el paciente crítico con COVID-19. Una revisión / Terapia nutricional no paciente crítico com COVID-19. Uma revisão

Resumen: Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos -incluido una menor sobrevida en UCI- son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI. Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2. Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés. Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2; sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas.

Summary Introduction: acute respiratory distress syndrome and multiple organ dysfunction, which determine admission to the ICU, are a significant cause of morbimortality in patients with COVID-19. The patients with the worst clinical outcome, including a shorter survival in the ICU, are those with multiple comorbilities, different immunocompromised states, older adults and individuals with a history of malnutrition or suffering from malnutrition secondary to a critical illness. The nutritional impact of the critical illness on the striated appearance of skeletal muscle fibers may be exacerbated in some critically ill patients who are infected with SARS-CoV-2 and need to be admitted to the ICU. Objective: this article aims to provide useful practical guidelines for clinicians based on updated clinical evidence and considering a few key characteristics that are specific to severe infection caused by SARS-Cov-2. Method: we conducted a thorough review of the scientific literature published until April 2020 in English and Spanish. Conclusions: the COVID-19 pandemic causes an unprecedented challenge in the ICU since up until today, no preventive measures have been proved successful to avoid evolution to critical illness and the therapies available for this stage of the disease are supported by quality clinical evidence. Within this complex framework we may trust that the measures that contribute to strengthening the immune system and ICU life-support therapies (including nutritional therapy) constitute essential tools to fight against severe infections caused by SARS-Cov-2. However, further studies are needed in the ICU scenario for specific recommendations to be made.

Resumo Introdução: o desconforto respiratório agudo e a falência de múltiplos órgãos que determinam a admissão na UTI são causas importantes de morbimortalidade em pacientes com COVID-19. Os pacientes com os piores resultados clínicos, incluindo menor sobrevida na UTI, são aqueles com múltiplas comorbidades, graus variáveis ??de imunocomprometimento, idosos e indivíduos com desnutrição prévia ou secundária à doença crítica. O impacto nutricional da doença crítica no músculo esquelético pode ser exacerbado em alguns pacientes graves infectados com SARS-CoV-2 que requerem internação na UTI. Objetivos: o objetivo deste artigo é fornecer orientação prática útil para os médicos baseada em evidências clínicas atualizadas e considerando certas características específicas principais da infecção grave por SARS-Cov-2. Métodos: foi realizada uma revisão exaustiva da literatura científica publicada até abril de 2020 em espanhol e inglês. Conclusões: a pandemia de COVID-19 determina um desafio sem precedentes na UTI, visto que atualmente não existem medidas preventivas comprovadas para prevenir a progressão a doença crítica e os tratamentos curativos disponíveis nesta fase da doença carecem de evidências clínicas de qualidade que os sustentem. Nesse cenário complexo, medidas que contribuem para estimular o sistema imunológico e terapias de suporte na UTI (incluindo suporte nutricional) são provavelmente armas substanciais contra infecções graves por SARS-Cov-2; no entanto, são necessários mais estudos em ambiente de UTI para fazer recomendações específicas.

Pharmaconutrition revisited for critically ill patients with coronavirus disease 2019 (COVID-19): Does selenium have a place?

Coronavirus disease 2019 (COVID-19) is a global pandemic causing one of the biggest challenges for critical care medicine. Mortality from COVID-19 is much greater in elderly men, many of whom succumb to acute respiratory distress syndrome (ARDS) triggered by the viral infection. Because there is no specific antiviral treatment against COVID-19, new strategies are urgently needed. Selenium is an essential trace element with antioxidant and immunomodulatory effects. Poor nutritional status increases the pathogenicity of viruses and low selenium in particular can be a determinant of viral virulence. In the past decade, selenium pharmaconutrition studies have demonstrated some reduction in overall mortality, including how reduced incidence of ventilator-associated pneumonia and infectious complications such as ARDS in the critically ill. Consequently, we postulate that intravenous selenium therapy, could be part of the therapeutic fight against COVID-19 in intensive care unit patients with ARDS and that outcomes could be affected by age, sex, and body weight. Our working hypothesis addresses the question: Could high-dose selenite pharmaconutrition, as an early pharmacologic intervention, be effective at reducing the incidence and the progression from type 1 respiratory failure (non-ARDS) to severe ARDS, multiorgan failure, and new infectious complications in patients with COVID-19 patients?